INSIDE THE ISSUE

> Find Your Place Campaign
> HPC Discussion on Finances
> Polls Show Discomfort with Insurers
> House Hospital Relief
> Disturbing DPH Report on Maternity
> Continued Flu Monitoring
> Transition

MONDAY REPORT

Massachusetts Healthcare Providers Launch United Workforce Campaign

“The healthcare field is truly a place for everyone, especially for people who are driven to make a difference.” said Michael Dandorph, president & CEO of Tufts Medicine. “Hospitals and health systems have built tremendous trust within their communities, and we are excited to harness the power they have as communicators to highlight the personal growth, teamwork, and sense of purpose that we see with our clinicians and staff members every day.”

“This campaign is another important action providers are taking to not only expand the healthcare workforce, but also to take pressure off current staff who are working tirelessly to ensure every patient gets the care they deserve,” added MHA’s Senior Vice President and Chief Innovation Officer Valerie Fleishman. “MHA and our members will continue to collaborate with policymakers and partners across healthcare to evolve this critical profession and meet the needs of today’s caregivers.”

The “Find Your Place in Healthcare” campaign includes social media materials translated into Cantonese, Haitian Creole, Mandarin, Portuguese, and Spanish. It is inclusive of all healthcare roles, from nurses and clinicians to administrative professionals and support staff.

As part of this unified effort, hospitals and health systems have signed on to incorporate this initiative into their ongoing recruitment efforts. They will be directing audiences to their job boards and career pages. MHA is encouraging anyone with an interest in the healthcare profession to reach out to their local healthcare organizations.

A Recognition that Financial Distress Affects Healthcare Costs

Discussion at last Wednesday’s Health Policy Commission (HPC) may have signaled a subtle, but important shift in the HPC’s main area of focus.

Since its inception a decade ago the HPC has closely hewed to its core mandate – setting a healthcare cost growth benchmark and attempting to rein in costs. To meet that mandate, much of the HPC’s focus has been on providers, and especially hospitals, which make up the greatest share of the “healthcare dollar.” Only in 2022 did the HPC include among its annual goals a heightened focus on pharmaceutical spending (although the commission still lacks regulatory authority to regulate prices in that area).

Last week, some HPC commissioners urged the agency to take a broader look at the entire healthcare continuum and how each part of it affects costs and prices. There also seemed to be a recognition that the HPC should not just focus on rising hospital prices but also on the financial pressures that are destabilizing the healthcare community.

After a staff discussion of the HPC’s annual goals and recommendations, Commissioner Martin Cohen, president & CEO of the MetroWest Health Foundation said it’s time for the commission to view the state’s healthcare system as a whole. He suggested a sort of periodic “stress test” of the care continuum’s components to identify those “that have the potential to continue to sort of muck up the system in terms of throughput or whatever else.”

Cohen added that a major part of the overall review must include the workforce issue. “That’s the biggest stress that’s gumming up the works now and obviously we have to think more effectively about strategies to overcome some of the workforce challenges and creating the right pipelines for health-related careers,” he said.

Executive Office of Health and Human Services Secretary Kate Walsh, who is also an HPC commissioner, noted that the items HPC focuses on – hospital costs, service closures, and more – do not occur in a vacuum.

“We spend a lot of time focused on the cost and price challenges that we face and that’s appropriate and our mandate, but the consequence behind this is that hospitals find themselves facing financial challenges which, by the way, fuel some of these service closure questions,” Walsh said.

She added that as the healthcare system changes, the HPC may also have to change its focus to review segments of the system – such as long-term care, hospital at home programs, and pre-hospital care programs, among others – and determine how the combined elements of the system affect costs and healthcare prices.

Asked how the HPC could be involved in such an overall financial review, Walsh said the data already exists. “CHIA tracks it. You can read that there’s probably a billion dollars in hospital losses this year [FY2022]” and that the losses in 2023 will probably be in excess of $500 million, she said. “I think it should at least influence our thinking on the benchmark. Because if the benchmark is working but is driving people out of business, or closing service where we don’t think they should be closed, then I think we have to think about that,” Secretary Walsh said.

MHA President & CEO Steve Walsh, who helped create the HPC when he served in the state legislature, but who has been a consistent advocate for broadening its mandate to meet the dynamic nature of the healthcare marketplace, lauded the commission for its discussion. “Massachusetts healthcare is still teetering on the edge, and its providers are in need of reforms that can help them stabilize, support their workforce, and ultimately keep services available to patients,” Walsh said. “MHA and our members fully support any efforts that will address these needs, and we believe they should be the at the center of every healthcare policy conversation. For Massachusetts to pursue meaningful new cost control measures, it is essential to first get its hospitals and health systems back on track.”

National Polls Find Continuing Concern With Insurance Company Practices

Three new polls conducted on behalf of the American Hospital Association (AHA) show growing concern among patients, nurses, and doctors over the practices of commercial health insurance companies.

Most patients (62%) polled say they have had medical care delayed by their insurance company and nearly half of that group (43%) say their health has gotten worse as a result of the delays.

A large majority (84%) of nurses polled believe insurance administrative policies delay patient care, and 74% of nurses say such policies reduce the quality of care. Sixty-three percent of R.N.s say insurer actions interfere with a patient being transferred to the right care setting. (An MHA report released in June found that private insurance administrative barriers are the leading reasons why there are 1,200 patients stuck in Massachusetts acute care hospitals awaiting transfer to the next level of care.)

The poll of physicians found that 80% believe insurance practices and policies affect their ability to practice medicine, with 84% saying such practices make it difficult for them to operate a solo practice. Fifty-six percent of nurses say their job satisfaction has decreased because of insurance practices.

The surveys were conducted by Morning Consult between December 2022 and April 2023, and involved a sample of 1,502 adults, 500 nurses, and 500 physicians. Results have a margin of error plus or minus three or four percentage points.

House’s Supplemental Budget Contains Funding Relief for Hospitals

The Massachusetts House last Thursday voted to approve a $700 million supplemental budget that contains $180 million in emergency relief to some acute care hospitals. In making the appropriation, the House recognizes that the effects of the COVID-19 pandemic – while considered by much of the general public to be a resolved thing of the past – still roils the healthcare sector. Hospitals are now being met with difficult decisions on how to maintain service lines and face worsening bond ratings that will make it harder for them to borrow, further worsening their finances.

“Massachusetts had the lowest rate of preventable deaths in the country during the COVID-19 crisis, a direct result of the strong partnership between our elected officials and providers to keep the healthcare system afloat,” said MHA President & CEO Steve Walsh. “Those efforts also came at a steep financial cost, and healthcare organizations are now under serious financial distress.

“MHA and our members are tremendously grateful for the hospital relief that the House passed. It reflects the continued level of commitment among state leadership – just as we saw throughout the pandemic – to protect patients, and now to help providers recover. We look forward to remaining closely engaged with our partners in the Senate as this proposal continues through the legislative process.”

Health System Beset by Structural Racism Endangers Black Maternity

A data brief from the Massachusetts Department of Public Health released last week shows that severe medical morbidity (SMM) nearly doubled in Massachusetts between 2011 and 2020 and that Black, non-Hispanic individuals giving birth persistently experience the highest SMM rates among all populations.

Severe medical morbidity is defined “as unexpected complications of labor and delivery that result in significant short- or long-term consequences to the birthing person’s health.” Such occurrences include life-threatening conditions and the use of life-saving procedures. There were 52.3 SMMs per 10,000 deliveries in 2011 and nearly double (100.4) in 2020, DPH reports.

Large disparities in SMM rates not only exist among different populations but have persisted consistently or worsened among Black, non-Hispanic pregnant people over the years. “These persistent disparities arise from inequities in care and access, social and economic factors, and the enduring effects of structural racism,” DPH wrote. The disparities are “heavily influenced by the social determinants of health.”

While SMM rates increase with age – that is, older, pregnant, childbearing individuals face greater risks – Black, non-Hispanic childbearing individuals had the highest SMM rates for every age group. The same is true for people with a heavier body weight; the greater body mass index pre-pregnancy leads to greater complications during birth. But pregnant patients who are Black had the highest SMM rates for all BMI categories.

The DPH report also found that pregnant individuals with specific disabilities, both physical and neurological, had higher rates of SMM and that social factors “such as active and passive denial of medical care, inequitable access to social determinants of health such as housing and proper nutrition, and higher rates of other risk factors” lead to SMM in people who are differently abled.

“To improve peripartum health outcomes, state policy efforts must continue to target structural racism and ableism, as well as other socioeconomic and community drivers of adverse maternal outcomes, including access to and quality of primary and prenatal care,” DPH wrote.

DPH Still Wants Clinicians to Test for Flu Variants

The flu season in Massachusetts has ended meaning that the Department of Public Health will not update its weekly flu dashboard until the next influenza reporting season in October. But last week, DPH indicated that it, along with the federal Centers for Disease Control Protection (CDC) still encourages clinicians to assist with ongoing surveillance for variant influenza cases. Specifically, CDC and DPH are “encouraging an increase in testing and subtyping over the summer months when influenza testing may not be as routine as it is during the fall and winter months,” particularly in ICU patients with respiratory illness.

Requested actions include continuing flu testing in patients, particularly in ICU patients with respiratory illness. Subtyping of positive samples in hospital or clinical laboratories or sending the samples to the state’s public health laboratory; and forwarding any unsubtypable specimens to the state lab for additional testing.

Transition

John LoDico, Editor